Top hospital cover
Top hospital insurance offers the convenience and comfort of private care for all major treatments.
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With top hospital cover, you don't have to worry about what treatments are or aren't covered by your health insurance policy. That's because most top policies cover the full suite of medically necessary treatments.
The comfort and convenience of private care really shines when you're giving birth, having your hip replaced, undergoing dialysis, having an insulin pump applied or going through any number of expensive and complicated treatments. Top cover makes that happen for you.
Compare top hospital policies
Below you'll find a selection of gold hospital policies from Finder partners. Gold is the top level of health insurance available, and includes cover for pregnancy, IVF, cataracts, joint replacement and more - which aren't covered by other levels of health insurance.
Ready to explore more options? Use our free comparison tool to compare side by side options and quotes from Australian health funds.
There are different levels of private hospital insurance available, but not all of them cover everything you may need, so for complete peace of mind, many people choose to take out top hospital health insurance. This is the highest level of cover available and usually covers private hospital treatment for all services where Medicare pays a benefit. The four levels of hospital cover are:
- Top cover. Top hospital covers all services where Medicare pays a benefit. While top hospital cover is more expensive than other levels of private hospital cover, the costs can be offset somewhat by choosing to pay an excess or a co-payment. You might also see this referred to as Gold cover.
- Medium cover. Medium cover provides all the benefits offered by a basic policy in addition to other services, which may include joint replacement or birth related services. Restrictions and exclusions apply. This is sometimes referred to as Silver cover.
- Basic cover. Basic in-hospital cover usually excludes a range of services including non-cosmetic plastic surgery, psychiatric services and rehab. This is sometimes called Bronze cover.
- Public hospital. Public hospital cover provides you with the minimum benefits for treatment in a public hospital.
These four tiers are beginning to be overhauled starting on 1 April 2019 and concluding in April 2020. This means that some health funds already have policies that fall into one of four categories: Basic, Bronze, Silver and Gold, while others are still using the old classification. These somewhat align with the current tiers, but the new system will make it much easier to compare policies side-by-side.
While top hospital cover is more expensive than other levels of private hospital cover, the costs can be offset somewhat by choosing to pay an excess or a co-payment.
What is an excess?
An excess is an additional amount you contribute towards the cost of a service, while a co-payment is a daily amount you pay towards your costs for every day you are in hospital. With one or both of these included in your policy, you can substantially reduce the cost of your premiums.
What does top hospital cover?
While basic and medium levels of private hospital cover restrict or exclude a range of services, top hospital cover includes every service where Medicare pays a benefit. That means, where lower levels of cover won’t include things like pregnancy and birth related services, assisted reproductive services, cataract and eye lens procedures, joint replacements and renal dialysis, top hospital will cover them all. A good top hospital policy will also cover services like:
- 100% emergency ambulance services
- Tonsils, adenoids and appendix removal
- Surgical removal of wisdom teeth
- Palliative care
- Spinal fusion
- Psychiatric treatment
- Rehabilitation treatment
- Heart-related medical and surgical admissions
- Medically necessary plastic and reconstructive surgery
- Assisted reproductive services (like IVF)
- Weight loss surgery such as gastric banding
Under the new system rolling out in April 2019, many top policies will become known as Gold policies. The major difference is that any policy labelled Gold will be required to offer all of the services above and a host of others or they won't get the Gold label.
Who can benefit from top hospital cover?
Two of the main benefits offered by top hospital private health insurance, that are often not included in lower levels of cover, are assisted reproductive services and cataract and eye-related services. So if you are planning to start a family and are looking at procedures such as IVF (In-Vitro Fertilisation) or GIFT (Gamete Intrafallopian Transfer), both of which can be expensive with no guarantees of success, having top hospital insurance to cover the in-hospital portion of these procedures can be highly beneficial. You will still have some out-of-pocket expenses for services performed outside of hospital, such as specialist visits and various tests, but the hospital part will be covered up to certain benefit limits. Similarly with eye-related services such as cataract removal or refractive lens exchange (RLE), having top hospital cover for the in-hospital portion of the procedure will go a long way towards covering your costs. Medicare provides a rebate for part of the cost and your top hospital insurance will cover some or all of the rest.
Are there any exclusions?
Despite providing top level protection, there are some things even top hospital private health insurance will not cover. The main ones are:
- Services performed outside of Australia. Surgical procedures and associated costs incurred in another country will not be covered. If you’re planning to save money by having an operation overseas (often referred to as medical tourism), don’t expect your top hospital insurance to pick up the tab.
- Services that are not deemed clinically necessary. Services such as cosmetic surgery, which do not attract a Medicare rebate because they are not considered medically necessary, are also not covered by top hospital cover.
2019 Health Insurance Reforms
The private health insurance industry is currently undergoing a major set of reforms. Some took effect in 2018, but the majority have begun to launch in April 2019, and will continue into April 2020. Here are some of the highlights:
- A new Basic, Bronze, Silver and Gold tier system will make it easier to compare policies side-by-side.
- Customers will have easier access to mental health treatments.
- The cost of prosthetic devices will go down, helping to reduce the pressure on rising premiums.
- Insurers will be able to offer discounts to people aged 18-29.
- Some natural therapies will be cut from extras policies to help bring premium costs down.
- You can choose to increase your excess as a way to reduce your premium.
- Insurers will be able to offer rural customers cover for their transportation and accommodation costs.
Beware the gap
The main thing to be aware of with any of these in-hospital services is that if your doctor or specialist charges more than the Medicare Benefit Schedule (MBS) fee, there is likely to be a “gap” between what Medicare will cover (75% of the MBS fee) and what your top hospital insurance will reimburse you (25% of the MBS fee). This will result in an out-of-pocket expense, unless your health fund has a Medical Gap Scheme to help cover the difference. If your doctor or specialist participates in their particular scheme, then you won’t have to pay any gap costs. It’s important to talk to your fund before being admitted to hospital to make sure you are fully covered by your top hospital insurance. Picture: Shutterstock
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